Changes in marital status as a result of marriage, divorce, death, or birth or adoption of a child may affect your beneficiaries. Be sure to review your Beneficiary Designation forms. The death of your beneficiary revokes a designation you may currently have on file with CalPERS. You may also want to review your current Power of Attorney, or consider completing a CalPERS Special Power of Attorney form.

Checklist, what do I need to do?

• Determine what beneficiaries changes are needed.
• Determine what plans are affected.
• Complete the necessary form(s).
• Submit or bring the documents to the Human Resources Department for processing.

Make an appointment or visit the Human Resources Department with all the necessary paperwork to commence the enrollment process or if you need more information.

A temporary or permanent disability can impact your coverage or benefits, to learn more about it, please check out the following options/programs.

Checklist, what do I need to do?

• Immediately inform your immediate supervisor.
• Submit appropriate paperwork.
• Contact Human Resources to determine how your benefits may be impacted or schedule a meeting to discuss your options.

Different Options to Consider:

Depending on the extent and type of disability, you may have the following options:

• Time off with or without pay.
• Catastrophic leave if all accruals have been used.
• Disability Insurance benefits.
• Other voluntary benefits.
• Withdrawing funds from your Deferred Compensation Plan account.
• Interactive Meeting to determine reasonable accommodations.
• Release to return to work to full or modified duty or with restrictions.
• Disability Retirement.

Time off with or without pay:

If your disability is temporary, you may just need time off. If you have enough accruals, you may be able to take your entire leave with pay. However, if you do not have sufficient accruals, you will have to request a Leave of Absence without Pay. You can supplement your income by obtaining donations through the Catastrophic Leave Donation program or by obtaining benefits through the City provided Disability Insurance Plans. In addition, if you have purchased voluntary disability insurance through AFLAC, you will be eligible to collect those benefits. Lastly, you can withdraw your funds from your Deferred Compensation Plan account if you have an unforeseeable emergency ("hardship"); however, your plan may limit the withdrawal to a portion of your account. In the event that you need a Leave of Absence without pay, your benefit coverage may lapse during leave. To avoid any disruption to your health coverage, contact the Human Resources Department immediately for completion of a Direct Payment Authorization Form to pay your premium directly to the insurance carrier(s). If you do not elect to direct pay, your health coverage will be cancelled. You may need to re-enroll in a CalPERS health plan once you return to work or once your retirement is approved by CalPERS.

Interactive Meeting to Determine Reasonable Accommodations:

For injured or disabled employees in California, there are two forms of protection:

• The Americans with Disability Act (the ADA) and
• The Fair Employment and Housing Act (FEHA).

An employee who has suffered from a qualifying disability and is able to perform the essential functions of the job with or without accommodations is covered. A protected disability is a medical condition, physical or mental disability that makes the achievement of a major life activity difficult. The City is required to engage in a timely, good faith interactive process with a disabled employee in determining whether reasonable accommodations exist that would enable the employee to perform his/her job. Upon receipt of your doctor's information, a Human Resources staff member will contact you to schedule an interactive meeting to determine reasonable accommodations.

Release to Return to Work:

If you are released to return to work full or modified duty, or have temporary or permanent restrictions, you must submit the doctor's report to your immediate supervisor who will forward a copy to the Human Resources Department. You will only be able to return to work with a release from your doctor. However, if you are released to modified duty or with restrictions, a Human Resources Department staff member will contact you to engage in an interactive meeting to discuss the impact of the modified duty or restrictions.

Disability Retirement:

• If your disability appears to be permanent and you will be unable to perform the essential functions of your current position with the City, you may be eligible for a disability retirement. Review Disability and Industrial Disability Retirement for more information.
• Review and complete the Guide to Completing Your Disability Retirement Election Application.
• Complete and return all the required forms to CalPERS.
• CalPERS can expedite an emergency retirement for those facing a terminal illness. If this is your case, Contact CalPERS or the Human Resources Department immediately for special assistance.
• You must meet specific requirements to continue your health insurance coverage into retirement or to maintain the right to re-enroll in the future after retirement.
• In the event that you become disabled, your coverage may lapse during the processing of your disability retirement application. To avoid any disruption to your health coverage, contact the Human Resources Department for completion of a Direct Payment Authorization Form to pay your premium directly to the insurance carrier(s). If you do not elect to direct pay, your health coverage will be cancelled. You may need to re-enroll in a CalPERS health plan once your disability retirement is approved.

If you're facing a terminal illness, we can assist you in making sure your coverage or benefits are in place to have your wishes carried out. It is important that you or your next of kin contact the Human Resources Department as soon as possible. Please take in consideration the following areas when planning for your beneficiaries.

Your Retirement:

• If you are retirement eligible, Contact CalPERS or the Human Resources Department about the possibility of filing for retirement as soon as possible. A CalPERS emergency retirement counselor will advise you of actions you should take or expedite retirement processing if you are terminally ill.
• Assist your family members by letting them know the steps they'll need to take to receive benefits. Review the latest information to ensure death benefits are paid to the proper beneficiaries.
• Be sure to review your beneficiaries to ensure it is accurate and up to date.
• You should complete a CalPERS Special Power of Attorney to designate your attorney-in-fact to conduct your retirement affairs.
• Contact the Human Resources Department, your union, and the Social Security Administration to determine if there are any other benefits payable.
• Hospitals and doctors often have counselors and other resources to help you identify benefits that may be available to you.

Your Health, Dental and Life Benefits Coverage:

• Review your health plan's Evidence of Coverage publication so that you are familiar with hospice coverage, and share this information with your family members.
• If you're still working, you should contact the Human Resources Department to determine the continuing coverage of your surviving family members after your death. They can also help explain how coverage may be continued through COBRA.
• Contact CalPERS to find out how your emergency retirement can affect continuation of health coverage for your eligible surviving family members.
• Consider your wishes for end-of-life care and discuss them with your family and your doctor. If you need help identifying your wishes, Finding Your Way: A Guide for End-Of-Life Medical Decisions from Sacramento Healthcare Decisions provides helpful suggestions. 
• Make sure you have an Advance Health Care Directive (also known as a Durable Power of Attorney for Health Care) in place and that your family and your doctor have copies. The form can be found on the California Coalition for Compassionate Care or Sacramento Healthcare Decisions websites.

Other Benefits:

• If you are a member of the Long-Term Care Program or bought additional policies through AFLAC, please contact AFLAC directly to coordinate any benefits that may be available to you.
• If you are a part of the Deferred Compensation Plan, you should contact your savings plan if you have any questions on benefits or to review or change your beneficiary information.

Review the information below to see how the birth or adoption of a child impacts your coverage or benefits.

Checklist, What do I need to do?

• For natural born child(ren): provide a copy of the birth certificate.
• For adopted child(ren): provide a copy of the adoption paperwork.
• For step-child(ren): provide a copy of the marriage certificate.
• For other child(ren): provide an affidavit of Parent-Child Relationship and supporting documentation such as court records, school records, tax returns, or additional proof that a parent-child relationship exists.
• Provide social security number for your child(ren).
• Add child(ren) to Health Plan, Dental Plan, and/or Vision Plan.
• Determine if additional life insurance is necessary.
• Review my beneficiaries and make the necessary changes.

Requirements:

• Newborn children should be added within thirty (30) days of birth. Coverage is effective the first day of the following month after the date of birth. 
• Newly adopted children should be added within thirty (30) days of physical custody. Coverage is effective from the date physical custody is obtained.
• Stepchildren or a domestic partner's children under age 26 can be added within thirty (30) days after the date of your marriage or registration of your domestic partnership. The coverage will become effective the first day of the month following the date the Human Resources Department receives the Health Benefit Plan Enrollment form.
• Dependents in a Parent-Child Relationship must be added within thirty (30) days from the date you obtained custody of the child(ren). To add a child(ren) up to age of 26 under this provision to your health plan both of the following criteria must be met: You have assumed a parent-child relationship and you are considered the primary care parent. Prior to the enrollment, you must complete and submit an Affidavit of Parent-Child Relationship. You may be asked to provide supporting documentation such as court records, school records, tax returns, or additional proof that a parent-child relationship exists. A parent-child relationship must be certified at the time of enrollment for each child and annually thereafter up to age 26. Coverage will become effective the first day of the month following the date the Human Resources Department receives the Health Benefit Enrollment form.
• A child over the age of 26 who is incapacitated of self-support because of a mental or physical condition that existed prior to age 26 and continuously since age 26 may be included at your initial enrollment. This enrollment is subject to CalPERS approval. Prior to enrollment of a disabled child over the age of 26, you must submit a Member Questionnaire for the CalPERS Disabled Dependent Benefit form, and your doctor must complete and submit a Medical Report for the CalPERS Disabled Dependent Benefit form for CalPERS approval. You must update these forms periodically upon request.

Make an appointment or visit the Human Resources Department with all the necessary paperwork to commence the enrollment process or if you need more information.

If you have changed your name for any reason, such as marriage or divorce, be sure to follow these simple steps to update your personal information with the City. The Human Resources Department is only able to change your official name to match your Social Security card. For more information about changing your name, please see the link below to the Social Security Administration website.

Checklist, What do I need to do?

• Inform your department Administrative Assistant who will process a Personnel
• Action form with your name change.
• Submit a copy of your Social Security Card.
• Determine if you need to make any beneficiaries changes. For beneficiary changes, please review the "Adding or Changing Beneficiaries" section.
• Complete any necessary forms.
• Submit or bring to the Human Resources Department for processing.

Other Resources:

Social Security Administration: Marriage, Divorce and Name Changes.

Death of an Active Employee:

Upon your passing, your surviving spouse, registered domestic partner, a family member or a designee must notify the Human Resources Department as soon as possible. A Human Resources staff member will assist your spouse, registered domestic partner, family member or designee with coordination of all benefits, necessary paperwork, and any questions they may have.

What would your Family Member/Designee Need?

• Date, time of death.
• Report it to the Human Resources Department by calling (909) 620-2291.
• A copy of your death certificate will be necessary.

What Happens Next?

• A Human Resources staff member will contact CalPERS and notify them of the death. 
• CalPERS will send your family member the necessary paperwork to determine who will be the beneficiary and what benefits will be paid. The Death Benefit Application publication, which includes the necessary forms, can only be obtained upon reporting a death to CalPERS. It cannot be ordered online.
• Your family member must complete and return all the forms to CalPERS, along with the required documentation shown in the package he/she will receive. CalPERS will need a copy of the death certificate.
• If you were eligible to retire on the date of death, your surviving family member will be eligible for continuation of health benefits provided they were eligible at the time of death and qualify for a monthly survivors check.
• Surviving family members who do not meet the above qualifications may be eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) Continuation coverage. 
• Your family member must return all of the City property/equipment assigned to you to the City as soon as possible. 
• If you were a member of the Death Benefit Fund Program at time of death, a check will be prepared and distributed to your beneficiary within 48 hours of the notification of the death. 
• Your final check will be issued to the beneficiary listed on the Check Recipient Designation form the next pay period. 
• If you had a Deferred Compensation Plan account, your family member must contact Mass Mutual Life Insurance Company to coordinate withdrawal of funds. 
• If you had other voluntary plans, your family member must contact each company to coordinate withdrawal or cancellation of the benefit.

Death of Spouse, Registered Domestic Partner, or Dependent:

You must report the death of a spouse, registered domestic partner, or dependent to the Human Resources Department as soon as possible.

You are responsible for ensuring that the health enrollment information about you and your family members is accurate, and for reporting any changes in a timely manner. If you fail to maintain current and accurate health enrollment information, you may be liable for the reimbursement of health premiums or health care services incurred during the entire ineligibility period. Changes in marital status such as divorce or terminating a domestic partnership may affect your health enrollment.

Checklist, What do I need to do?

• Complete the necessary forms.
• Have a copy of your final Divorce Decree or Termination of Domestic Partnership.
• Submit or bring documents to the Human Resources Department for processing.

Requirements:

• When you divorce or terminate a registered domestic partnership, your former spouse or registered domestic partner is no longer eligible to receive health, dental, or vision benefits under your coverage plan.
• The coverage terminates on the first day of the month following the date of the divorce decree or termination of registered domestic partnership is granted.

Review the information below to see how getting married or registering a domestic partner impacts your coverage or benefits. To find out more about registering a domestic partnership, visit the Secretary of State's website. Upon registration, that office will provide you with a Declaration of Domestic Partnership. You will need this declaration to add your partner to your benefits plans.

Checklist, What do I need to do?

• A copy of your marriage certificate or a copy of Declaration of Domestic Partnership.
• You will need your spouse or domestic partner's Social Security Number.
• Add new spouse or domestic partner to my Health Plan or determine if you will enroll in the cash-in-lieu program.
• Add new spouse or domestic partner to my Dental Plan.
• Determine if additional life insurance is necessary.
• Review my beneficiaries and make the necessary changes.
• Complete the necessary forms.
• Submit or bring the documents to the Human Resources Department for processing.

Requirements:

• Must complete paperwork within thirty (30) days from date of marriage or registration of your domestic partnership. If enrollment is not completed within this timeframe, you will have to wait for the next open enrollment period. 
• Coverage will be effective on the first day of the month following the date the City receives the enrollment form.
• Review your beneficiary designation forms. Your marriage or registration of domestic partnership revokes a designation you may currently have on file with CalPERS. Each benefit may require different beneficiary designation forms you need to complete, be sure you use the correct version.

Make an appointment or visit the Human Resources Department with all the necessary paperwork to commence the enrollment process or if you need additional information.

It’s important that the City has your correct mailing address so we can ensure you receive all your benefit information and W-2 in a timely manner.

To change your address, please do the following:

• Inform your department Administrative Assistant who will process a Personnel Action form with your address change.
• Contact the Human Resources Department as soon as possible to determine if a health plan change is necessary.

Dependent children (natural, adopted, domestic partner's or step) up to the age of 26 are eligible to remain on your plan(s). However, once they reach the age of 26, you must immediately remove them from your plans. It is against the law to continue enrollment for ineligible family members/dependents. If you do, you may have to pay all costs incurred by the ineligible person from the date the coverage began. Please ensure that you promptly visit the Human Resources Department to delete your dependents. The effective date of the action will be the first of the following month from date of ineligibility. Review the information below to see how you can remove your depending children from your coverage or benefits:

Checklist, What do I need to do?

• Complete forms (Medical, Dental, Vision, Additional Life Insurance).
• Provide reason for deletion.

If your employment relationship with the City of Pomona is ending, please review the information below to see how leaving will impact your coverage or benefits:

Checklist, What do I need to do?

• If you are voluntarily resigning, submit your resignation notice to your immediate supervisor.
• Complete the necessary forms. 
• If you are retiring, inform your immediate supervisor as soon as possible and visit the Planning My Retirement page. 
• Sign the Personnel Action form completed by your department's Administrative Assistant.
• Return all City property and/or equipment on your last day of employment. 
• Contact the Human Resources Department determine how your benefits will be impacted or if you need to continue your benefits under COBRA.

What Happens Next?

• If you leave your job for reasons other than retirement, you are covered under your Health Insurance until the first day of the second month following the last date you were employed. This is subject to you having sufficient earnings to cover your share of the health premium. If you are retiring visit the Planning My Retirement page. 
• Your other coverage (life or voluntary plans) will end at the end of the month unless you continue them under COBRA or through an Individual Conversion Policy directly with the company. 
• If you elect to cancel your coverage before you leave your job due to a qualifying event, your benefits will not continue and you will not be eligible for COBRA Continuation Coverage.
• If you decide to permanently separate from all CalPERS-covered employment, you may leave your member contributions and interest in your account and receive a retirement benefit as soon as you meet the minimum retirement eligibility requirements. Or you may elect to refund or rollover your contributions to a qualified savings plan providing you have not accepted employment covered under another publicly funded California retirement system. View important information on our Refund of Member Contributions page.
• If you are moving from one CalPERS-covered employer to another, you may not withdraw your retirement contributions. You must be permanently separated from all CalPERS-covered employment before you may terminate your CalPERS membership and receive a return of retirement contributions. In addition, CalPERS has agreements with many publicly funded California retirement systems which permit movement between public employers within a specific time period without loss of retirement rights. If you are moving to a position covered under CalSTRS, Legislators’ Retirement System, University of California Retirement Plan, Judges’ I/II Retirement System or other agencies, you may not be able to withdraw your retirement contributions. For additional information about your rights and responsibilities, view the When You Change Retirement Systems publication.